Newsmaker: Anthony Fauci

GWEN IFILL: AIDS, Africa, and the president’s new plan to fight the disease. Earlier today, I spoke with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, about today’s announcement.

GWEN IFILL: Dr. Fauci, thank you for joining us.

DR. ANTHONY FAUCI: It’s good to be here.

GWEN IFILL: So describe for us what the president’s approach is today on AIDS.

DR. ANTHONY FAUCI: Well, the president launched a new program that’s directed at the interruption, or the prevention of transmission of HIV from pregnant women to their babies at the time of birth, through pregnancy, or during breast-feeding. It’s a program that is part of the broad general approach of trying to do something to interrupt the spread of this epidemic in a catastrophic way, and particularly in developing countries; the most hard hit of which are those in sub-Saharan Africa and the Caribbean.

And what the program does, it aims in two separate phases. One is more of a low-tech phase where you involve involuntary counseling and testing of pregnant women, determine if they’re HIV-infected, and to use a therapeutic approach, which is really very simple. It’s a single dose of the drug to the mother during labor, and a single dose to the baby within 48 hours of birth. And that has shown to decrease the transmissibility by about 50 percent. The program is a program that’s scoped out for about five years, and at the end of the fifth year, you should reach the point…

GWEN IFILL: $500 million program.

DR. ANTHONY FAUCI: Yeah, it’s a $500 million program, about a million…$100 million a year. But the goal, and I think it’s an attainable goal, is to be able to save the lives, in the sense of preventing infection, in 145,000…146,000 children per year by the end of the fifth year, which is a really quite…quite an important advance if we can do that.

GWEN IFILL: Why the focus on mother-child transmission rather than adult-to-adult transmission?

DR. ANTHONY FAUCI: Sure. Sure. And that’s an excellent question. Certainly this is… this is not excluding other things that we’ll be doing with the global AIDS trust fund and a variety of other programs at the CDC, and the NIH and others. But the reason for focusing in this particular arena of mother-to-child transmission is that in order to provide therapy for adults who are already infected for the period of time – essentially, indefinitely – you would need a health care infrastructure that just doesn’t exist right now.

That doesn’t mean that we’re not going to be partnering with other nations to try and build up to that, but it’s a very difficult thing to do. What this is, it’s treatment that serves as a prevention. It isn’t treatment for an indefinite period of time of people who are already infected; it’s treating the mother to be able to block transmission to the baby. So it’s a combination of a treatment program, which its end-effect is actually prevention.

GWEN IFILL: But if you’re saving the children…

DR. ANTHONY FAUCI: Right.

GWEN IFILL: …And not necessarily taking care of the mother, don’t you run the risk of leaving orphans?

DR. ANTHONY FAUCI: Of course. That’s the obvious question, that there’s a problem with, would you leave the child who’s escaped infection as an orphan. Again, part of the program is to actually provide comprehensive therapy to a certain proportion of the mothers. You can’t do that if the infrastructure doesn’t exist. So it isn’t as if the government… the president is focusing only on this to the exclusion of the others.

What we’re saying is that right now we can have an impact on spread from mother to child at the same time that we’re participating in a more comprehensive program of building up infrastructure to be able to treat people so that you can keep mother and father alive. But that’s something that is logistically difficult to do – not impossible, but it’s going to require lot more resources and a lot of collaboration among multiple nations, among NGOs, non-government organization, and it will require an infrastructure that just is not there yet.

GWEN IFILL: You’re probably aware that critics of this have said it is just a drop in the bucket; that when you talk about how much more the administration is willing to spend down the road, it’s going to come too late at a time when AIDS in sub-Saharan Africa is projected to double in five years.

DR. ANTHONY FAUCI: Well, I think you have to remember certain things. First of all, we have a $500 million commitment to the Global AIDS Trust Fund. That clearly is more than anyone else is doing. That doesn’t mean that’s going to be the only amount. And the president made it very clear that what he’s doing here is not a substitute for the Global AIDS Trust Fund, nor does it eliminate or push it aside. It’s in addition to; it’s complimentary. So if this were being a substitute, you’d say, “well, you know, you’re going in one direction and not in the other.” That’s not the case at all, and the president made that very clear in his remarks today.

GWEN IFILL: And what about the drug of choice in this treatment program? Nevirapine?

DR. ANTHONY FAUCI: Yeah, Nevirapine.

GWEN IFILL: Why this drug?

DR. ANTHONY FAUCI: Well, this drug is an important drug because in a clinical trial in sub-Saharan Africa, it was shown that if you give us just a single dose at the right time, the half-life of the drug, or the duration of time that the drug hangs around is just enough to get through that period of time of the high probability of transmission from a mother to a baby during birth at the time of labor and delivery. And if you give it to the baby, you even put icing on the cake for that. We still have the problem, obviously, that we’re going to have to address one way or the other of breast-feeding, of the added infection that would occur through breast-feeding. And that’s the reason why it’s part of the program, though it’s restricted somewhat because of the lack of the infrastructure is to treat the mother beyond just the birth of the baby so that as you’re treating the mother, you can then continue to block transmissibility through breast-feeding.

GWEN IFILL: How do you monitor the success of an effort like that?

DR. ANTHONY FAUCI: Well, you monitor the success because you know what the percentages of infected pregnant women are. You know what the percentage of transmissibility… it’s about 30 percent or more in sub-Saharan Africa. So if a mother is… if a woman is pregnant and infected, there’s at least a 30 percent chance. What you’ll be able to monitor is that when you follow these women, you’ll be able to determine if you have that projected decrease in transmissibility and the mathematical modeling that was done indicates the numbers that I mentioned to you, that at the end of the five-year period, we hopefully will have 145,000, 146,000 babies per year who otherwise would have been infected who are not infected.

That’s the measurement, and I think that’s the reason why the president is high on this program, because it has quantifiable endpoints. It isn’t something just vague where you just put money in and you hope that something good happens. These are quantifiable endpoints that we’ll be looking for.

GWEN IFILL: One more question on the money. Democrats and Republicans in the Senate were prepared to spend much more than this. What guarantees do they have that, as you say, there will be more money down the road to broaden this kind of… this kind of effort?

DR. ANTHONY FAUCI:I think that when we have success, which I certainly hope and think we will, that that will be the incentive to put money in, and that’s what we’re expecting: that when see quantifiable results, which is one of the good reasons why this, I think, is a good program, that when people see that, then that’s a very good incentive to say, “let’s put more money in.”

GWEN IFILL: Okay. Dr. Anthony Fauci, thank you very much for joining us.

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